MIGUEL JIMENEZ, Applicant vs. YANG WU INTERNATIONAL INC. and CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, self-administered, for TOWER SELECT/AMTRUST/ CASTLEPOINT, in liquidation, Defendants
ADJ number
ADJ9091752
Decision date
Oct 25, 2022
District office
Oxnard
WCJ
William M. Carero
Claim administrator
California Insurance Guarantee Association (CIGA), self-administered for Tower Select/AmTrust/CastlePoint, in liquidation
Commissioners
—
Injury / body parts: neck, back, chest, shoulders, respiratory system, teeth/dental (claimed by lien claimant)
Lien claimant Dental Trauma Center (DTC) sought reconsideration of a WCJ's February 27, 2020 Findings and Order disallowing its lien for dental evaluation and treatment provided to applicant Miguel Jimenez, a shipping clerk who had sustained an accepted industrial injury to his neck, back, chest, shoulders, and respiratory system. The underlying injury was found compensable in 2014 and resolved by Compromise and Release in July 2016; no dental injury was ever pleaded or alleged. DTC's dentist, Dr. Schames, issued a Doctor's First Report on July 15, 2016 (three days before settlement) and an 'Initial Report' on July 29, 2016 (eleven days after settlement). The WCAB affirmed the WCJ, holding that DTC failed to carry its burden of proving the treatment was reasonably required to cure or relieve the effects of the industrial injury and failed to establish a contested claim to support a medical-legal charge. The Board found Dr. Schames' reports did not constitute substantial evidence because they offered conclusions without supporting reasoning.
Issues
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Holding
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Analysis
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Applicant takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Defense takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Provider takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Similar decisions
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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